【摘要】 目的通过在心脏手术停搏液中加入外源性磷酸肌酸(CP),评价CP对先天性心脏病患儿窦性心律自动恢复率、正性肌力药物用量及缺血再灌注损伤指标肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(c Tn I)、血浆脑钠肽(BNP)的影响。方法选择2011年6月—2013年6月40例先天性心脏病儿童为研究对象。按照入院先后顺序分成观察组和对照组各20例。对照组给予改良St.Thomas’Ⅱ号心脏停搏液,观察组在停搏液中另加入注射用磷酸肌酸钠。记录2组体外循环时间,升主动脉阻断时间,窦性心律自动恢复率等电生理指标;记录2组术后24 h正性肌力药物的用量;分别测定主动脉插管前(T0)、开放循环后30 min(T1)、术后6 h(T2)、12 h(T3)、24 h(T4)的CK-MB,c Tn I、BNP。结果观察组窦性心律自动恢复率高于对照组[(96.71±8.03)%vs.(71.29±7.18)%,P<0.05]。观察组术后24 h、48 h多巴胺用量[(2.21±1.21)μg/(kg·min),(1.32±0.79)μg/(kg·min)]明显低于对照组[(4.18±1.42)μg/(kg·min),(3.21±0.96)μg/(kg·min),P<0.05]。观察组T1、T2、T3、T4时CK-MB、c Tn I、BNP水平低于对照组(P<0.05)。2组T1时CK-MB、c Tn I明显较T0时升高(P<0.01),后开始回落。结论手术停搏液中使用外源性CP,可提高窦性心律自动恢复率,减少正性肌力药物用量,并降低患儿缺血再灌注损伤。更多还原

【Abstract】 Objective To evaluate cardiac arrest liquid adding exogenous creatine phosphate effect on congenital heart disease sinus rhythm automatic recovery rate and positive inotropic drug dosage and ischemia-reperfusion injury index creatine kinase isoenzyme( CK-MB),cardiac troponin I( c Tn I),the influence of plasma brain natriuretic peptide( BNP).Methods From June 2011 to June 2013,40 cases of congenital heart disease were selected as the object of study. In accordance with the order of admission they were divided into the observation group and the control group with 20 cases in each. The control group received the modified St. Thomas’ II cardioplegic solution,and the observation group was given the creatine phosphate sodium for injection in cardioplegic solution. Recording two groups of cardiopulmonary bypass time,aortic blocking time,automatic recovery of electrophysiological index of sinus rhythm; amount of 24 h of inotropic drugs after operation in the two groups was recorded; CK-MB,c Tn I and BNP were measured before( T0) aortic cannulation,30 min after the open loop( T1),6 h after operation( T2),12 h( T3),24 h( T4). Results Sinus rhythm automatic recovery rate of observation group was higher than that of the control group [( 96. 71 ± 8. 03) % vs.( 71. 29 ± 7. 18) %,P <0. 05]. Dopamine dosage observed in 24 h,48 h dopamine dosage group[( 2. 21 ± 1. 21) μg /( kg·min),( 1. 32 ± 0. 79)μg /( kg·min) ]was significantly lower than that of the control group[( 4. 18 ± 1. 42) μg /( kg·min),( 3. 21 ± 0. 96)μg /( kg·min) ],P < 0. 05. The T1,T2,T3,T4 CK-MB,c Tn I,BNP levels in observation group were lower than those of the control group( P < 0. 05). Two groups’ T1 and T0 CK-MB,c Tn I were significantly increased( P < 0. 01),then decreased. Conclusion Congenital heart disease operation using exogenous CP in cardioplegia,can improve the automatic recovery rate of sinus rhythm,reduce the positive inotropic drug dosage,and reduce ischemia reperfusion injury.更多还原